Implications of left ventricular asynergy

Ventricular asynergy, local disturbances in ventricular wall motion which disrupt the normal coordinated pattern of left ventricular contraction, is described in a group of patients. There are four distinct types of asynergy: (1) akinesis, or local absence of wall motion; (2) dyskinesis, or local expansile or paradoxical wall motion; (3) asyneresis, or geometric distortion or inequality of wall motion; and (4) asynchrony, or a disturbed temporal sequence of contraction. These local abnormalities are closely related to anatomic, electrocardiographic and biochemical zones of ischemia in coronary heart disease and are also seen in cardiomyopathy and with ectopic excitation and activation of the left ventricle. Although often associated with clinical and more frequently, laboratory evidence of cardiac failure, asynergy sometimes occurs in the absence of cardiac enlargement. Such morphologic abnormalities provide a functional basis for the hemodynamic disturbances seen in coronary heart disease and so poorly explained at postmortem examination. Thus, ventricular asynergy represents a dynamic abnormality appreciated only in life as a derangement of the integrated function of the left ventricle and represents an important cause of cardiac failure.